Distinct brain activation patterns for human maximal voluntary eccentric and concentric muscle actions

Neuro-orthopaedic check-up and walking in people with multiple sclerosis: toward a more specific assessment to improve rehabilitation results

The rehabilitation process of people with multiple sclerosis (PwMS) is a challenge, and decision-making requires a thorough assessment to increase the chances of success in rehabilitation planning. The aim of this study was to investigate the importance of the neuroorthopaedic check-Up (NOChU) for gait prognosis. Participated in the study 105 PwMS with different levels of impairment. The NOChU includes measurements of passive range of motion (ROM), muscle strength, and spasticity. Additionally, was carried out the spatial-temporal analysis of the walking, Timed Up and Go test, and 6-min walk test. ROM remained relatively preserved to perform daily life activities except for ankle dorsiflexion. Muscle strength was also relatively preserved. Spasticity affected especially the ankle muscles, clearly the sural triceps. Among the NOChU measurements the catch seemed to have the most impact on walking on its different phases and on other activities. Accurate NOChU measurements play a crucial role in clinical settings, guiding informed decisions in rehabilitation planning. Future research endeavours could focus on exploring the correlations between NOChU deficiencies and the decline in walking capabilities among PwMS, with the goal of proposing personalized treatment strategies that address their specific requirements.

Muscle-tendon unit length changes in knee extensors and flexors during alpine skiing

This study characterised the thigh muscle-tendon unit length variations (MTUv) in elite alpine skiing. MTUv were modelled for seven muscles from knee and hip angles in 17 national team skiers during 1602 cycles (546 Slalom (SL), 908 Giant-Slalom (GS), 136 Super-Giant (SG) and 12 Downhill (DH) cycles). The biarticular rectus femoris showed a dynamic pattern on both legs, especially in SL. On the other side, vastii displayed a stable length on the inside leg in all disciplines (37-46% of the cycle), contrasting with their dynamic behaviour on the outside leg being quasi-static for only 3% (SL) to 27% (DH) of the cycle. SL showed the largest amplitude of MTUv followed by GS, SG and DH. For vastus lateralis, MTUv was ~60%Lr.s-1 in SL but only ~12%Lr.s-1 in DH. In SL, a fine desynchronisation between both joints led to nearly constant MTUv (slow lengthening lasting ~45-51% of the cycle) for the biarticular hamstrings separated by faster variations during turn switch from outside to inside leg. In summary, biarticular MTUv were not characterised by single-joint behaviours, suggesting that extrapolating contraction regimen from knee joint only is not accurate in alpine skiing.

Eccentric cycling involves greater mental demand and cortical activation of the frontoparietal network

Eccentric, compared to concentric exercise, is proposed to involve different neuro-motor processing strategies and a higher level of mental demand. This study compared eccentric and concentric cycling at matched perceived effort and torque for the mental demand and related-cortical activation patterns. Nineteen men (30 ± 6 years) performed four different 5-min cycling conditions at 30 RPM on a semi-recumbent isokinetic cycle ergometer: (1) concentric at a moderate perceived effort (23 on the CR100® scale) without torque feedback; (2) concentric and (3) eccentric at the same average torque produced in the first condition; and (4) eccentric at the same moderate perceived effort than the first concentric condition. The conditions two to four were randomized. After each condition, mental demand was monitored using the NASA Task Load Index scale. Changes in oxy-(O2 Hb) and deoxy-(HHb) hemoglobin during exercise were measured over both prefrontal cortices and the right parietal lobe from a 15-probe layout using a continuous-wave NIRS system. Mental demand was significantly higher during eccentric compared to concentric cycling (+52%, p = 0.012) and when the exercise intensity was fixed by the torque rather than the perceived effort (+70%, p < 0.001). For both torque- or perceived effort-matched exercises, O2 Hb increased significantly (p < 0.001) in the left and right prefrontal cortices, and right parietal lobe, and HHb decreased in the left, and right, prefrontal cortices during eccentric compared to concentric cycling. This study supports that acute eccentric cycling, compared to concentric cycling, involves a higher mental demand, and frontoparietal network activation.

Brain activation associated with low- and high-intensity concentric versus eccentric isokinetic contractions of the biceps brachii: An fNIRS study

Studies have shown that neural responses following concentric (CON) and eccentric (ECC) muscle contractions are different, which suggests differences in motor control associated with CON and ECC contractions. This study aims to determine brain activation of the left primary motor cortex (M1) and left and right dorsolateral prefrontal cortices (DLPFCs) during ECC and CON of the right bicep brachii (BB) muscle at low- and high-contraction intensities. Eighteen young adults (13M/5F, 21-35 years) were recruited to participate in one familiarization and two testing sessions in a randomized crossover design. During each testing session, participants performed either ECC or CON contractions of the BB (3 sets × 8 reps) at low- (25% of maximum ECC/CON, 45°/s) and high-intensity (75% of maximum ECC/CON, 45°/s) on an isokinetic dynamometer. Eleven-channel functional near-infrared spectroscopy was used to measure changes in oxyhemoglobin (O2 Hb) from the left M1, and left and right DLPFC during ECC and CON contractions. Maximum torque for ECC was higher than CON (43.3 ± 14.1 vs. 46.2 ± 15.7 N m, p = 0.025); however, no differences in O2 Hb were observed between contraction types at low or high intensities in measured brain regions. High-intensity ECC and CON contractions resulted in greater increases in O2 Hb of M1 and bilateral DLPFC compared to low-intensity ECC and CON contractions (p = 0.014). Our findings suggest no differences in O2 Hb responses between contraction types at high and low intensities. High-contraction intensities resulted in greater brain activation of the M1 and bilateral DLPFC, which may have implications for neurorehabilitation to increase central adaptations from exercise.

Effects of exercise treatment on functional outcome parameters in mid-portion achilles tendinopathy: a systematic review

Exercise interventions are evident in the treatment of mid-portion Achilles tendinopathy (AT). However, there is still a lack of knowledge concerning the effect of different exercise treatments on improving a specific function (e.g., strength) in this population. Thus, this study aimed to systematically review the effect of exercise treatments on different functional outcomes in mid-portion AT. An electronic database of Pubmed, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception to 21 February 2023. Studies that investigated changes in plantar flexor function with exercise treatments were considered in mid-portion AT. Only randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were included. Functional outcomes were classified by kinetic (e.g., strength), kinematic [e.g., ankle range of motion (ROM)], and sensorimotor (e.g., balance index) parameters. The types of exercise treatments were classified into eccentric, concentric, and combined (eccentric plus concentric) training modes. Quality assessment was appraised using the Physiotherapy Evidence Database scale for RCTs, and the Joanna Briggs Institute scale for CCTs. The search yielded 2,260 records, and a total of ten studies were included. Due to the heterogeneity of the included studies, a qualitative synthesis was performed. Eccentric training led to improvements in power outcomes (e.g., height of countermovement jump), and in strength outcomes (e.g., peak torque). Concentric training regimens showed moderate enhanced power outcomes. Moreover, one high-quality study showed an improvement in the balance index by eccentric training, whereas the application of concentric training did not. Combined training modalities did not lead to improvements in strength and power outcomes. Plantarflexion and dorsiflexion ROM measures did not show relevant changes by the exercise treatments. In conclusion, eccentric training is evident in improving strength outcomes in AT patients. Moreover, it shows moderate evidence improvements in power and the sensorimotor parameter "balance index". Concentric training presents moderate evidence in the power outcomes and can therefore be considered as an alternative to improve this function. Kinematic analysis of plantarflexion and dorsiflexion ROM might not be useful in AT people. This study expands the knowledge what types of exercise regimes should be considered to improve the functional outcomes in AT.

Repeated measurements of Adaptive Force: Maximal holding capacity differs from other maximal strength parameters and preliminary characteristics for non-professional strength vs. endurance athletes

The Adaptive Force (AF) reflects the neuromuscular capacity to adapt to external loads during holding muscle actions and is similar to motions in real life and sports. The maximal isometric AF (AFiso_max) was considered to be the most relevant parameter and was assumed to have major importance regarding injury mechanisms and the development of musculoskeletal pain. The aim of this study was to investigate the behavior of different torque parameters over the course of 30 repeated maximal AF trials. In addition, maximal holding vs. maximal pushing isometric muscle actions were compared. A side consideration was the behavior of torques in the course of repeated AF actions when comparing strength and endurance athletes. The elbow flexors of n = 12 males (six strength/six endurance athletes, non-professionals) were measured 30 times (120 s rest) using a pneumatic device. Maximal voluntary isometric contraction (MVIC) was measured pre and post. MVIC, AFiso_max, and AF_max (maximal torque of one AF measurement) were evaluated regarding different considerations and statistical tests. AF_max and AFiso_max declined in the course of 30 trials [slope regression (mean ± standard deviation): AF_max = -0.323 ± 0.263; AFiso_max = -0.45 ± 0.45]. The decline from start to end amounted to -12.8% ± 8.3% (p < 0.001) for AF_max and -25.41% ± 26.40% (p < 0.001) for AFiso_max. AF parameters declined more in strength vs. endurance athletes. Thereby, strength athletes showed a rather stable decline for AF_max and a plateau formation for AFiso_max after 15 trials. In contrast, endurance athletes reduced their AF_max, especially after the first five trials, and remained on a rather similar level for AFiso_max. The maximum of AFiso_max of all 30 trials amounted 67.67% ± 13.60% of MVIC (p < 0.001, n = 12), supporting the hypothesis of two types of isometric muscle action (holding vs. pushing). The findings provided the first data on the behavior of torque parameters after repeated isometric-eccentric actions and revealed further insights into neuromuscular control strategies. Additionally, they highlight the importance of investigating AF parameters in athletes based on the different behaviors compared to MVIC. This is assumed to be especially relevant regarding injury mechanisms.

Muscle oxygenation and time to task failure of submaximal holding and pulling isometric muscle actions and influence of intermittent voluntary muscle twitches

Background

Isometric muscle actions can be performed either by initiating the action, e.g., pulling on an immovable resistance (PIMA), or by reacting to an external load, e.g., holding a weight (HIMA). In the present study, it was mainly examined if these modalities could be differentiated by oxygenation variables as well as by time to task failure (TTF). Furthermore, it was analyzed if variables are changed by intermittent voluntary muscle twitches during weight holding (Twitch). It was assumed that twitches during a weight holding task change the character of the isometric muscle action from reacting (≙ HIMA) to acting (≙ PIMA).

Methods

Twelve subjects (two drop outs) randomly performed two tasks (HIMA vs. PIMA or HIMA vs. Twitch, n = 5 each) with the elbow flexors at 60% of maximal torque maintained until muscle failure with each arm. Local capillary venous oxygen saturation (SvO₂) and relative hemoglobin amount (rHb) were measured by light spectrometry.

Results

Within subjects, no significant differences were found between tasks regarding the behavior of SvO₂ and rHb, the slope and extent of deoxygenation (max. SvO₂ decrease), SvO₂ level at global rHb minimum, and time to SvO₂ steady states. The TTF was significantly longer during Twitch and PIMA (incl. Twitch) compared to HIMA (p = 0.043 and 0.047, respectively). There was no substantial correlation between TTF and maximal deoxygenation independently of the task (r = − 0.13).

Conclusions

HIMA and PIMA seem to have a similar microvascular oxygen and blood supply. The supply might be sufficient, which is expressed by homeostatic steady states of SvO₂ in all trials and increases in rHb in most of the trials. Intermittent voluntary muscle twitches might not serve as a further support but extend the TTF. A changed neuromuscular control is discussed as possible explanation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-022-00447-9.

The Eccentric Phase in Unilateral Resistance Training Enhances and Preserves the Contralateral Knee Extensors Strength Gains After Detraining in Women: A Randomized Controlled Trial

The current randomized controlled study investigated whether or not the inclusion of the eccentric phase in resistance training favors the contralateral strength gains after different unilateral protocols, and whether such gains are retained after detraining. Sixty healthy women were randomly assigned to a unilateral concentric-only (CONC), eccentric-only (ECC), concentric–eccentric (TRAD) volume-equated knee extension training or control group (CON). The participants trained 2 days/week for 8 weeks and then did not train for further 8 weeks. Knee extensors isokinetic concentric, eccentric, and isometric peak torque and vastus lateralis muscle thickness were assessed in the contralateral limb at baseline, post-training, and post-detraining. At post-training, concentric peak torque increased in CONC [+9.2%, 95%CI (+6.2/+12.3), p < 0.001, ES: 0.70, 95%CI (0.01/1.39)], ECC [+11.0% (+7.7/+14.2), p < 0.001: ES: 0.66(0.09/1.23)] and TRAD [+8.5%(+5.7/+11.6), p < 0.001, ES: 0.50(0.02/0.98)]. Eccentric peak torque increased in ECC in ECC [+15.0%(+11.4/+20.7), p < 0.001, ES: 0.91(0.14/1.63)] and TRAD [+5.5%(+0.3/10.7), p = 0.013, ES: 0.50(0.05/0.95)]. Isometric peak torque increased in ECC [+11.3(+5.8/16.8), p < 0.001, ES: 0.52(0.10/0.94)] and TRAD [+8.6%(+3.4/+13.7), p < 0.001, ES: 0.55(0.14/0.96)]. No change in eccentric and isometric peak torque occurred in CONC (p > 0.05). Muscle thickness did not change in any group (p > 0.05). At post-detraining, all groups preserved the contralateral strength gains observed at post-training (p < 0.05). The findings showed that ECC and TRAD increased contralateral knee extensors strength in concentric, eccentric, and isometric modality, while CONC only increased concentric strength. The eccentric phase appears to amplify the cross-education effect, permitting a transfer in strength gaining toward multiple testing modalities. Both eccentric-based and traditional eccentric–concentric resistance protocols are recommended to increase the contralateral retention in strength gains after a detraining period.

Eccentric rehabilitation induces white matter plasticity and sensorimotor recovery in chronic spinal cord injury

Experience-dependent white matter plasticity offers new potential for rehabilitation-induced recovery after neurotrauma. This first-in-human translational experiment combined myelin water imaging in humans and genetic fate-mapping of oligodendrocyte lineage cells in mice to investigate whether downhill locomotor rehabilitation that emphasizes eccentric muscle actions promotes white matter plasticity and recovery in chronic, incomplete spinal cord injury (SCI). In humans, of 20 individuals with SCI that enrolled, four passed the imaging screen and had myelin water imaging before and after a 12-week (3 times/week) downhill locomotor treadmill training program (SCI + DH). One individual was excluded for imaging artifacts. Uninjured control participants (n = 7) had two myelin water imaging sessions within the same day. Changes in myelin water fraction (MWF), a histopathologically-validated myelin biomarker, were analyzed in a priori motor learning and non-motor learning brain regions and the cervical spinal cord using statistical approaches appropriate for small sample sizes. PDGFRα-CreER^T2:mT/mG mice, that express green fluorescent protein on oligodendrocyte precursor cells and subsequent newly-differentiated oligodendrocytes upon tamoxifen-induced recombination, were either naive (n = 6) or received a moderate (75 kilodyne), contusive SCI at T9 and were randomized to downhill training (n = 6) or unexercised groups (n = 6). We initiated recombination 29 days post-injury, seven days prior to downhill training. Mice underwent two weeks of daily downhill training on the same 10% decline grade used in humans. Between-group comparison of functional (motor and sensory) and histological (oligodendrogenesis, oligodendroglial/axon interaction, paranodal structure) outcomes occurred post-training. In humans with SCI, downhill training increased MWF in brain motor learning regions (postcentral, precuneus) and mixed motor and sensory tracts of the ventral cervical spinal cord compared to control participants (P < 0.05). In mice with thoracic SCI, downhill training induced oligodendrogenesis in cervical dorsal and lateral white matter, increased axon-oligodendroglial interactions, and normalized paranodal structure in dorsal column sensory tracts (P < 0.05). Downhill training improved sensorimotor recovery in mice by normalizing hip and knee motor control and reducing hyperalgesia, both of which were associated with new oligodendrocytes in the cervical dorsal columns (P < 0.05). Our findings indicate that eccentric-focused, downhill rehabilitation promotes white matter plasticity and improved function in chronic SCI, likely via oligodendrogenesis in nervous system regions activated by the training paradigm. Together, these data reveal an exciting role for eccentric training in white matter plasticity and sensorimotor recovery after SCI.

Motor Cortical Excitability Changes in Preparation to Concentric and Eccentric Movements

Specific neural mechanisms operate at corticospinal levels during eccentric and concentric contractions. Here, we investigated the difference in corticospinal excitability (CSE) when preparing these two types of contraction. In this study we enrolled 16 healthy participants. They were asked to perform an instructed-delay reaction time (RT) task involving a concentric or an eccentric contraction of the right first dorsal interosseus muscle, as a response to a proprioceptive cue (Go signal) presented 1 s after a warning signal. We tested CSE at different time points ranging from 300 ms before up to 40 ms after a Go signal. CSE increased 300-150 ms before the Go signal for both contractions. Interestingly, significant changes in CSE in the time interval around the Go signal (from -150 ms to +40 ms) were only revealed in eccentric contraction. We observed a significant decrease in excitability immediately before the Go cue (Pre_50) and a significant increase 40 ms after it (Post_40) with respect to the MEPs recorded at Pre_150. Finally, CSE in eccentric contraction was lower before the Go cue (Pre_50) and greater after it (Post_40) compared to the concentric contraction. A similar result was also found in NoMov paradigm, used to disentangle the effects induced by movement preparation from those induced by the movement preparation linked to the proprioceptive cue. We could conclude that different neural mechanisms observed during concentric and eccentric contractions are mirrored with a different time-specific modulation of CSE in the preparatory phase to the movement.

Skeletal muscle and cerebral oxygenation levels during and after submaximal concentric and eccentric isokinetic exercise

The aim was to investigate the potential differences in muscle (vastus lateralis) and cerebral (prefrontal cortex) oxygenation levels as well as in the number of repetitions and total work output between isokinetic eccentric and concentric exercise at a moderate relative intensity until exhaustion. Ten recreationally active young men underwent two isokinetic exercise sessions either concentric or eccentric, one on each randomly selected leg. The protocols were performed at 60°/s and an intensity corresponding to 60% of the maximal voluntary contraction (MVC) of each contraction type. Concentric torque was significantly lower compared to eccentric torque in both peak values and at values corresponding to 60% of MVC [230 ± 18 Nm vs. 276 ± 19 Nm (P = .014) and 137 ± 12 Nm vs. 168 ± 11 Nm, respectively (P = .010)]. The participants performed 40% more contractions during eccentric compared to concentric exercise [122 ± 15 vs. 78 ± 7, respectively]. No differences were found in the levels of oxyhaemoglobin, deoxyhemoglobin, total haemoglobin and tissue saturation index when eccentric and eccentric exercise regimes were compared (all P > .05). Our results demonstrate that eccentric exercise of moderate intensity leads to greater resistance to fatigue and more work output compared to concentric exercise, despite the comparable muscle and cerebral oxygenation levels.

Eccentric exercise in the prevention of patellofemoral pain in high-volume runners: A rationale for integration

Patellofemoral pain (PFP) is a common overuse condition seen in high-volume runners, such as military recruits. Exercise is commonly prescribed, with benefit, for the rehabilitation of individuals with PFP. However, a substantial number of individuals with the condition do not achieve an optimal outcome, suggesting the condition can be difficult and complex. Given the challenging nature of the condition, and the risk of developing PFP in high-volume runners, it seems logical to investigate options for injury prevention. Eccentric exercise has been useful in the prevention of some pathologies so its utility in preventing PFP should be explored. Current evidence regarding prevention programs for PFP are limited. Preventative exercise programs for PFP have not been well described or reported, and questions remain regarding their effectiveness. Based on available evidence or lack thereof, and known physiological and clinical effects of eccentric exercise, suggestions for integration of eccentric exercise into PFP prevention programs are offered. Eccentric exercise may be useful for PFP prevention from a theoretical framework however additional longitudinal cohort studies would be useful in determining its utility.

Detection of effort maximality in adults performing isokinetic wrist flexion and extension

BACKGROUND: The difference between isokinetic eccentric to concentric strength ratios at high and low velocities (DEC) is a powerful tool for identifying submaximal effort in other muscle groups but its efficiency in terms of the wrist extensors (WE) and flexors (WF) isokinetic effort has hitherto not been studied. OBJECTIVE: The objective of the present study is to examine the usefulness of the DEC for identifying suboptimal wrist extensor and flexor isokinetic efforts. METHODS: Twenty healthy male volunteers aged 20–40 years (28.5 ± 3.2) were recruited. Participants were instructed to exert maximal and feigned efforts, using a range of motion of 20∘ in concentric (C) and eccentric (E) WE and WF modes at two velocities: 10 and 40∘/s. E/C ratios (E/CR) where then calculated and finally DEC by subtracting low velocity E/CR from high velocity ones. RESULTS: Feigned maximal effort DEC values were significantly higher than their maximal effort counterparts, both for WF and WE. For both actions, a DEC cutoff level to detect submaximal effort could be defined. The sensitivity of the DEC was 71.43% and 62.5% for WE ad WF respectively. The specificity was 100% in both cases. CONCLUSION: The DEC may be a valuable parameter for detecting feigned maximal WF and WE isokinetic effort in healthy adults.

Locomotor activities as a way of inducing neuroplasticity: insights from conventional approaches and perspectives on eccentric exercises

Corticospinal excitability, and particularly the balance between cortical inhibitory and excitatory processes (assessed in a muscle using single and paired-pulse transcranial magnetic stimulation), are affected by neurodegenerative pathologies or following a stroke. This review describes how locomotor exercises may counterbalance these neuroplastic alterations, either when performed under its conventional form (e.g., walking or cycling) or when comprising eccentric (i.e., active lengthening) muscle contractions. Non-fatiguing conventional locomotor exercise decreases intracortical inhibition and/or increases intracortical facilitation. These modifications notably seem to be a consequence of neurotrophic factors (e.g., brain-derived neurotrophic factor) resulting from the hemodynamic solicitation. Furthermore, it can be inferred from non-invasive brain and peripheral stimulation studies that repeated activation of neural networks can endogenously shape neuroplasticity. Such mechanisms could also occur following eccentric exercises (lengthening of the muscle), during which motor-related cortical potential (electroencephalography) is of greater magnitude and lasts longer than during concentric exercises (i.e., muscle shortening). As single-joint eccentric exercise decreased short- and long-interval intracortical inhibition and increased intracortical facilitation, locomotor eccentric exercise (e.g., downhill walking or eccentric cycling) may be even more potent by adding hemodynamic-related neuroplastic processes to endogenous processes. Besides, eccentric exercise is especially useful to develop relatively high force levels at low cardiorespiratory and perceived intensities, which can be a training goal alongside the induction of neuroplastic changes. Even though indirect evidence let us think that locomotor eccentric exercise could shape neuroplasticity in ways relevant to neurorehabilitation, its efficacy remains speculative. We provide future research directions on the neuroplastic effects and underlying mechanisms of locomotor exercise.

Leg Muscle Activity and Perception of Effort before and after Four Short Sessions of Submaximal Eccentric Cycling

Background: This study tested muscle activity (EMG) and perception of effort in eccentric (ECC) and concentric (CON) cycling before and after four sessions of both. Methods: Twelve volunteers naïve to ECC cycling attended the laboratory six times. On day 1, they performed a CON cycling peak power output (PPO) test. They then carried-out four sessions comprising two sets of 1 to 1.5-min cycling bouts at 5 intensities (30, 45, 60, 75, and 90% PPO) in ECC and CON cycling. On day 2 and day 6 (two weeks apart), EMG root mean square of the vastus lateralis (VL), rectus femoris (RF), biceps femoris (BF), and soleus (SOL) muscles, was averaged from 15 to 30 s within each 1-min bout and perception of effort was asked after 45 s. Results: Before the four cycling sessions, while VL EMG was lower in ECC than CON cycling, most variables were not different. Afterwards, ECC cycling exhibited lower RF EMG at 75 and 90% PPO (all p < 0.02), lower VL and BF EMG at all exercise intensities (all p < 0.02), and inferior SOL EMG (all p < 0.04) except at 45% PPO (p = 0.07). Perception of effort was lower in ECC cycling at all exercise intensities (all p < 0.03) but 60% PPO (p = 0.11). Conclusions: After four short sessions of ECC cycling, the activity of four leg muscles and perception of effort became lower in ECC than in CON cycling at most of five power outputs, while they were similar before.

Feasibility, safety and muscle activity during flywheel vs traditional strength training in adult patients with severe haemophilia

INTRODUCTION

Eccentric training has been associated with several specific physiological adaptations. The flywheel machine is one of the easiest ways of performing eccentric overload training. However, no studies evaluated its feasibility, safety and muscle activity in patients with haemophilia (PWH).

AIM

To evaluate feasibility and safety and compare muscle activity during flywheel vs weight machine knee extension exercise in severe PWH.

METHODS

Eleven severe PWH [mean age of 33.5 (8.1) years] participated in this cross-sectional study after receiving prophylactic treatment. Surface electromyography (EMG) signals were recorded for the rectus femoris during the knee extension exercise performed with 2 different conditions (flywheel and weight machine) with matched intensity (6 on the Borg CR10 scale). Kinesiophobia was assessed before and after the experimental session. Participants were asked to rate tolerability of each condition. Adverse effects were evaluated 24 and 48 hours after the session.

RESULTS

Kinesophobia did not increase after the experimental session, and no adverse effects were reported. At 60%-70% of the contraction cycle, the flywheel exercise showed higher (P = .024) eccentric rectus femoris muscle activity than the weight machine. In contrast, during the last 90%-100% of the contraction cycle, the traditional weight machine showed higher (P = .004) rectus femoris activity than the flywheel.

CONCLUSION

The knee extension exercise performed with the flywheel at moderate intensity is safe and well tolerated among severe PWH under adequate factor coverage. Importantly, the flywheel variation provides higher eccentric rectus femoris activity at the breaking force moment, while it provides lower eccentric muscle activity at the end of the cycle.

On-Field Ski Kinematic According to Leg and Discipline in Elite Alpine Skiers

This study used wireless technology to investigate joint kinematic characteristics of the four alpine skiing disciplines. Knee and hip angles were measured in 20 national team alpine skiers during 253 ski runs under FIS regulation, including: 85 Slalom (SL), 123 Giant Slalom (GS), 29 Super Giant Slalom (SG), and 16 Downhill (DH). Data were analyzed by outside (OL, n = 2,087) and inside leg (IL, n = 2,015). The proportion of concentric and eccentric phases (extension and flexion respectively for the knee extensors) as well as the proportion of the quasi-isometric phase defined between ±20°.s⁻¹ depended on the discipline in interaction with the IL/OL (p < 0.001). The results showed a lower knee quasi-isometric duration on OL in SL (11%) than other disciplines (DH: 38%; SG: 42%; GS: 34%, p < 0.001, d > 1.8), suggesting a highly dynamic style. Quasi-isometric mode was significantly longer on OL than IL in GS (34 vs. 20%, p < 0.001, d = 1.16) and SG (42 vs. 28%, p < 0.001, d = 1.11) but was significantly longer on IL than OL in SL (19 vs. 11%, p < 0.001, d = 0.64). Thus, GS and SG showed similarities, with a significantly faster knee eccentric mean angular velocity on IL compared to OL (GS −58 vs. −54°.s⁻¹, SG −52 vs. −45°.s⁻¹, p < 0.001, d ≥ 0.22) whereas SL showed an opposite pattern (−72 vs. −89°.s⁻¹, p < 0.001, d = 1.10). The quasi-isometric phase was overlooked in previous studies but is crucial to consider. The current data may be used to train the outside and inside leg specificities incorporating discipline-specific contraction modes and exercises.

Global Corticospinal Excitability as Assessed in A Non-Exercised Upper Limb Muscle Compared Between Concentric and Eccentric Modes of Leg Cycling

This study investigated the effects of eccentric (ECC) and concentric (CON) semi-recumbent leg cycling on global corticospinal excitability (CSE), assessed through the activity of a non-exercised hand muscle. Thirteen healthy male adults completed two 30-min bouts of moderate intensity ECC and CON recumbent cycling on separate days. Power output (POutput), heart rate (HR) and cadence were monitored during cycling. Global CSE was assessed using transcranial magnetic stimulation to elicit motor-evoked potentials (MEP) in the right first dorsal interosseous muscle before (‘Pre’), interleaved (at 10 and 20 mins, t10 and t20, respectively), immediately after (post, P0), and 30-min post exercise (P30). Participants briefly stopped pedalling (no more than 60 s) while stimulation was applied at the t10 and t20 time-points of cycling. Mean POutput, and rate of perceived exertion (RPE) did not differ between ECC and CON cycling and HR was significantly lower during ECC cycling (P = 0.01). Group mean MEP amplitudes were not significantly different between ECC and CON cycling at P0, t10, t20, and P30 and CON (at P > 0.05). Individual participant ratios of POutput and MEP amplitude showed large variability across the two modes of cycling, as did changes in slope of stimulus-response curves. These results suggest that compared to ‘Pre’ values, group mean CSE is not significantly affected by low-moderate intensity leg cycling in both modes. However, POutput and CSE show wide inter-participant variability which has implications for individual neural responses to CON and ECC cycling and rates of adaptation to a novel (ECC) mode. The study of CSE should therefore be analysed for each participant individually in relation to relevant physiological variables and account for familiarisation to semi-recumbent ECC leg cycling.

Implementing Eccentric Resistance Training-Part 1: A Brief Review of Existing Methods

The purpose of this review was to provide a physiological rationale for the use of eccentric resistance training and to provide an overview of the most commonly prescribed eccentric training methods. Based on the existing literature, there is a strong physiological rationale for the incorporation of eccentric training into a training program for an individual seeking to maximize muscle size, strength, and power. Specific adaptations may include an increase in muscle cross-sectional area, force output, and fiber shortening velocities, all of which have the potential to benefit power production characteristics. Tempo eccentric training, flywheel inertial training, accentuated eccentric loading, and plyometric training are commonly implemented in applied contexts. These methods tend to involve different force absorption characteristics and thus, overload the muscle or musculotendinous unit in different ways during lengthening actions. For this reason, they may produce different magnitudes of improvement in hypertrophy, strength, and power. The constraints to which they are implemented can have a marked effect on the characteristics of force absorption and therefore, could affect the nature of the adaptive response. However, the versatility of the constraints when prescribing these methods mean that they can be effectively implemented to induce these adaptations within a variety of populations.

Corticospinal excitability changes following downhill and uphill walking

Locomotor exercise may induce corticospinal excitability and/or cortical inhibition change in the knee extensors. This study investigated whether the mode of muscle contraction involved during a locomotor exercise modulates corticospinal and intracortical responsiveness. Eleven subjects performed two 45-min treadmill walking exercises in an uphill (+ 15%) or a downhill (- 15%) condition matched for speed. Maximal voluntary isometric torque (MVIC), voluntary activation level (VAL), doublet (Dt) twitch torque, and M-wave area of the knee extensors were assessed before and after exercise. At the same time-points, motor-evoked potential (MEP), cortical silent period (CSP), and short-interval cortical inhibition (SICI) were recorded in the vastus lateralis (VL) and rectus femoris (RF) muscles. After exercise, uphill and downhill conditions induced a similar loss in MVIC torque (- 9%; p < 0.001), reduction in VAL (- 7%; p < 0.001), and in M-wave area in the VL muscle (- 8%; p < 0.001). Dt twitch torque decreased only after the downhill exercise (- 11%; p < 0.001). MEP area of the VL muscle increased after the downhill condition (p = 0.007), with no change after the uphill condition. MEP area of the RF muscle remained stable after exercises. CSP and SICI did not change in the two conditions for both muscles. Downhill walking induces an increase in MEP area of the VL muscle, with no change of the CSP duration or SICI ratio. The eccentric mode of muscle contraction during a locomotor exercise can modulate specifically corticospinal excitability in the knee extensors.

Reviewing the Variability-Overuse Injury Hypothesis: Does Movement Variability Relate to Landing Injuries?

PURPOSE

Overuse injuries are common in sport, but complete understanding of injury risk factors remains incomplete. Although biomechanical studies frequently examine musculoskeletal injury mechanisms, human movement variability studies aim to better understand neuromotor functioning, with proposed connections between overuse injury mechanisms and changes in motor variability.

METHOD

In a narrative review, we discuss the variability-overuse injury hypothesis, which suggests repeated load application leads to mechanical tissue breakdown and subsequent injury when exceeding the rate of physiological adaptation. Due to the multidisciplinary nature of this hypothesis, we incorporate concepts from motor control, neurophysiology, biomechanics, as well as research design and data analysis. We therefore summarize multiple perspectives while proposing theoretical relationships between movement variability and lower extremity overuse injuries.

RESULTS

Experimental data are presented and summarized from published experiments examining interactions between experimental task demands and movement variability in the context of drop landing movements, along with comparisons to previous movement variability studies.

CONCLUSION

We provide a conceptual framework for sports medicine researchers interested in predicting and preventing sports injuries. Under performance conditions with greater task demands, we predict reduced trial-to-trial movement variability that could increase the likelihood of overuse injuries.

Supraspinal Control of Recurrent Inhibition during Anisometric Contractions

PURPOSE

Increase in recurrent inhibition was observed during eccentric compared with isometric and concentric maximal voluntary contractions but the neural mechanisms involved in this specific control of the Renshaw cell activity are unknown. This study was designed to investigate the supraspinal control of the recurrent inhibition during anisometric contractions of the plantar flexor muscles.

METHODS

To that purpose, the paired Hoffmann-reflex (H-reflex) technique permitted to assess changes in homonymous recurrent pathway by comparing the modulations of test and conditioning H-reflexes (H' and H1, respectively) in the soleus (SOL) muscle during maximal and submaximal isometric, concentric and eccentric contractions. Submaximal contraction intensity was set at 50% of the SOL electromyographic activity recorded during maximal isometric contraction. Fourteen volunteer subjects participated in an experimental session designed to assess the activity of the recurrent inhibition pathway.

RESULTS

The results indicate that the amplitude of H1 normalized to the maximal M-wave were similar (P > 0.05) regardless of the muscle contraction type and intensity. Whatever the contraction intensity, the ratio between H' and H1 amplitudes was significantly decreased (P < 0.05) during eccentric compared with isometric and concentric contractions. Furthermore, this ratio was significantly smaller (P < 0.05) during submaximal compared with maximal contractions whatever the muscle contraction type.

CONCLUSION

Together, the current results confirm the supraspinal control of the Renshaw cell activity when muscle contraction intensity is modulated and show that this control remains similar for isometric, concentric and eccentric contractions. Data further suggest that recurrent inhibition pathway may serve as variable gain regulator at motoneuronal level to improve resolution in the control of motor output for the SOL during eccentric contractions.

Effect of corporal suspension and pendulum exercises on neuromuscular properties and functionality in patients with medullar thoracic injury

BACKGROUND

Traumatic spinal cord injury (TSCI) is one of the most devastating injuries that has a physical impact on patients. The CHORDATA® method involves suspension and pendulous exercises and has been clinically used to treat patients with TSCI. Although empirically used to treat neurological patients, there is no scientific evidence of the efficacy of this method.

PURPOSE

To evaluate the chronic effects of CHORDATA® method on torque, muscle activation, muscle thickness, and functionality in patients with traumatic spinal cord injury.

METHODS

Twenty-six male patients with medullar thoracic injury were randomly categorised into two groups: intervention group (n = 14) and control group (n = 12). Rehabilitation program comprised of 16 sessions of body suspension and pendulum exercises (twice/week). The maximal voluntary isometric trunk flexion and extension torques, muscle activation and thickness (external and internal oblique, rectus and transversus abdominis, longissimus, and multifidus muscles), and functionality (adapted reach test) were evaluated before and after of rehabilitation program.

FINDINGS

A significant increase was observed in maximal voluntary isometric torque (flexion, 58%; extension, 76%), muscle activation of the rectus abdominis muscle, and muscle thickness of all intervention group muscles, without changes in the control group. Compared to the pre-intervention period, the intervention group also showed improvement in functionality at post-intervention, but no such differences were noted in the control group.

INTERPRETATION

The corporal suspension and pendulum exercises training improved rectus abdominis muscle activation, trunk muscles structure and strength, and reaching capacity in medullar thoracic injury patients.

Using first bout effect to study the mechanisms underlying eccentric exercise induced force loss

INTRODUCTION

The first bout of eccentric exercise is known to have a protective effect on the consequent bouts. This effect is still disputable as it is not known whether it protects muscle damage by reducing force production or by improving force recovery in the healing process. The underlying mechanisms of this protective effect have not been fully understood.

OBJECTIVES

To determine the mechanisms of this protective effect, three different loads were used for the first eccentric bout. This was done to investigate whether the protective effect is related to the size of the load in the first bout. To determine the neural adaptations, voluntary activation was assessed and to determine the muscular adaptations, the resting twitch was measured.

METHOD

Thirty healthy participants were selectively allocated into three groups (low-, moderate- and high-load group) to match for maximal voluntary contraction (MVC) (n = 10 per group). Participants in each group performed only one of the three sets of ten eccentric (ECC) exercises of the elbow flexors (10%, 20% and 40% of MVC) as their first eccentric bout. The second bout of eccentric exercise was performed two weeks later and was identical for all the three groups, i.e., 40% ECC.

RESULTS

The results showed that for the first bout, MVC, voluntary activation and the resting twitch displayed significant (p < 0.0001) interaction (group x time). This was not the case however for the second bout as there was no significant (group x time) interaction in all outcome variables immediately after exercise. When the first and second bouts were compared, it was found that the high-load group had faster recovery in MVC at day 1 and 4 corresponding to voluntary activation and only at day 4 corresponding to the resting twitch.

CONCLUSIONS

In this study, it was found that high-load exercise aids fast recovery either via neural or muscular adaptations.

Potential Health Benefits From Downhill Skiing

Objectives: Downhill skiing represents one of the most popular winter sports worldwide. Whereas a plethora of studies dealt with the risk of injury and death associated with downhill skiing, data on its favorable health effects are scarce. A more comprehensive overview on such effects might emerge from a multidisciplinary perspective.

Methods: A literature search has been performed to identify original articles on downhill/alpine skiing interventions or questionnaire-based evaluation of skiing effects and the assessment of health effects (cardiorespiratory, neurophysiological, musculoskeletal, psycho-social).

Results and Discussion: A total of 21 original articles dealing with potentially favorable health effects resulting from downhill skiing were included in this review. Results indicate that downhill skiing, especially when performed on a regular basis, may contribute to healthy aging by its association with a healthier life style including higher levels of physical activity. Several other mechanisms suggest further favorable health effects of downhill skiing in response to specific challenges and adaptations in the musculo-skeletal and postural control systems, to exposures to cold temperatures and intermittent hypoxia, and/or emotional and social benefits from outdoor recreation. However, reliable data corroborating these mechanisms is scarce.

Corticospinal changes induced by fatiguing eccentric versus concentric exercise

The present study assessed neuromuscular and corticospinal changes during and after a fatiguing submaximal exercise of the knee extensors in different modes of muscle contraction. Twelve subjects performed two knee extensors exercises in a concentric or eccentric mode, at the same torque and with a similar total impulse. Exercises consisted of 10 sets of 10 repetitions at an intensity of 80% of the maximal voluntary isometric contraction torque (MVIC). MVIC, maximal voluntary activation level (VAL) and responses of electrically evoked contractions of the knee extensors were assessed before and after exercise. Motor evoked potential amplitude (MEP) and cortical silent period (CSP) of the vastus medialis (VM) and rectus femoris (RF) muscles were assessed before, during and after exercise. Similar reductions of the MVIC (-13%), VAL (-12%) and a decrease in the peak twitch (-12%) were observed after both exercises. For both VM and RF muscles, MEP amplitude remained unchanged during either concentric or eccentric exercises. No change of the MEP amplitude input-output curves was observed post-exercise. For the RF muscle, CSP increased during the concentric exercise and remained lengthened after this exercise. For the VM muscle, CSP was reduced after the eccentric exercise only. For a similar amount of total impulse, concentric and eccentric knee extensor contractions led to similar exercise-induced neuromuscular response changes. For the two muscles investigated, no modulation of corticospinal excitability was observed during or after either concentric or eccentric exercises. However, intracortical inhibition showed significant modulations during and after exercise.

Effects of Parkinson disease and antiparkinson medication on central adaptations to repetitive grasping

Cortical activity during motor task performance is attenuated in individuals with Parkinson disease (PD) relative to age-matched adults without PD, and this activity is enhanced with antiparkinson medication. It remains unclear, however, whether the relative change in cortical activity over the duration of the task, i.e., central adaptation, is affected individuals with PD, and if so, whether medication corrects for any unique behaviors. Movement-related cortical potentials (MRCPs) were recorded from scalp electrode sites Cz and C1 during 150 repetitive handgrip contractions at 70% of maximal voluntary contraction, in individuals with PD (n = 10) both ON and OFF of their PD medication, and neurologically normal age- and sex-matched controls (n = 10). Repetitions were divided into two Blocks (Block 1 and 2: repetitions 1-60 and 91-150, respectively), and the composite MRCP slopes were calculated during periods representing movement initiation (-2 s to movement onset) and execution (movement onset to 1 s). No significant interactions were noted for either comparison (PD OFF vs. control; PD OFF vs. PD ON), irrespective of electrode site (Cz or C1) or movement period (initiation or execution). Despite similar MRCP slopes and task performance, PD OFF endorsed greater perceived exertion during task performance than controls. In the present study, we observed attenuated task-related cortical activity among individuals with PD OFF relative to controls, but a similar relative adaptive response to a fatiguing task. Additionally, although antiparkinson medication enhanced cortical activity (PD OFF vs. PD ON), central adaptation was similar.

Different Hemodynamic Responses of the Primary Motor Cortex Accompanying Eccentric and Concentric Movements: A Functional NIRS Study

The literature contains limited evidence on how our brains control eccentric movement. A higher activation is expected in the contralateral motor cortex (M1) but consensus has not yet been reached. Therefore, the present study aimed to compare patterns of M1 activation between eccentric and concentric movements. Nine healthy participants performed in a randomized order three sets of five repetitions of eccentric or concentric movement with the dominant elbow flexors over a range of motion of 60&deg; at two velocities (30&deg;/s and 60&deg;/s). The tests were carried out using a Biodex isokinetic dynamometer with the forearm supported in the horizontal plane. The peak torque values were not significantly different between concentric and eccentric movements (p = 0.42). Hemodynamic responses of the contralateral and ipsilateral M1 were measured with a near-infrared spectroscopy system (Oxymon MkIII, Artinis). A higher contralateral M1 activity was found during eccentric movements (p = 0.04, &eta;&sup2; = 0.47) and at the velocity of 30&deg;/s (p = 0.039, &eta;&sup2; = 0.48). These preliminary findings indicate a specific control mechanism in the contralateral M1 to produce eccentric muscle actions at the angular velocities investigated, although the role of other brain areas in the motor control network cannot be excluded.

Effects of muscle action type on corticospinal excitability and triceps surae muscle-tendon mechanics

This study investigated whether the specific motor control strategy reported for eccentric muscle actions is dependent on muscle mechanical behavior. Motor evoked potentials, Hoffman reflex (H-reflex), fascicle length, pennation angle, and fascicle velocity of soleus muscle were compared between isometric and two eccentric conditions. Ten volunteers performed maximal plantarflexion trials in isometric, slow eccentric (25°/s), and fast eccentric (100°/s) conditions, each in a different randomized testing session. H-reflex normalized by the preceding M wave (H/M) was depressed in both eccentric conditions compared with isometric ( P < 0.001), while no differences in fascicle length and pennation angle were found among conditions. Furthermore, although the fast eccentric condition had greater fascicle velocity than slow eccentric ( P = 0.001), there were no differences in H/M. There were no differences in motor evoked potential size between conditions, and silent period was shorter for both eccentric conditions compared with isometric ( P = 0.009). Taken together, the present results corroborate the hypothesis that the central nervous system has an unique activation strategy during eccentric muscle actions and suggest that sensory feedback does not play an important role in modulating these muscle actions. NEW & NOTEWORTHY The present study provides new insight into the motor control of eccentric muscle actions. It was demonstrated that task-dependent corticospinal excitability modulation does not seem to depend on sensory information processing. These findings support the hypothesis that the central nervous system has a unique activation strategy during eccentric muscle actions.

Brain activation associated with eccentric movement: A narrative review of the literature

The movement occurring when a muscle exerts tension while lengthening is known as eccentric muscle action. Literature contains limited evidence on how our brain controls eccentric movement. However, how the cortical regions in the motor network are activated during eccentric muscle actions may be critical for understanding the underlying control mechanism of eccentric movements encountered in daily tasks. This is a novel topic that has only recently begun to be investigated through advancements in neuroimaging methods (electroencephalography, EEG; functional magnetic resonance imaging, fMRI). This review summarizes a selection of seven studies indicating mainly: longer time and higher cortical signal amplitude (EEG) for eccentric movement preparation and execution, greater magnitude of cortical signals with wider activated brain area (EEG, fMRI), and weaker brain functional connectivity (fMRI) between primary motor cortex (M1) and other cortical areas involved in the motor network during eccentric muscle actions. Only some differences among studies due to the forms of movement with overload were observed in the contralateral (to the active hand) M1 activity during eccentric movement. Altogether, the findings indicate an important challenge to the brain for controlling the eccentric movement. However, our understanding remains limited regarding the acute effects of eccentric exercise on cortical regions and their cooperation as functional networks that support motor functions. Further analysis and standardized protocols will provide deeper insights into how different cortical regions of the underlying motor network interplay with each other in increasingly demanding muscle exertions in eccentric mode.

Virtual Proprioception for eccentric training

Wireless inertial sensors enable quantified feedback, which can be applied to evaluate the efficacy of therapy and rehabilitation. In particular eccentric training promotes a beneficial rehabilitation and strength training strategy. Virtual Proprioception for eccentric training applies real-time feedback from a wireless gyroscope platform enabled through a software application for a smartphone. Virtual Proprioception for eccentric training is applied to the eccentric phase of a biceps brachii strength training and contrasted to a biceps brachii strength training scenario without feedback. During the operation of Virtual Proprioception for eccentric training the intent is to not exceed a prescribed gyroscope signal threshold based on the real-time presentation of the gyroscope signal, in order to promote the eccentric aspect of the strength training endeavor. The experimental trial data is transmitted wireless through connectivity to the Internet as an email attachment for remote post-processing. A feature set is derived from the gyroscope signal for machine learning classification of the two scenarios of Virtual Proprioception real-time feedback for eccentric training and eccentric training without feedback. Considerable classification accuracy is achieved through the application of a multilayer perceptron neural network for distinguishing between the Virtual Proprioception real-time feedback for eccentric training and eccentric training without feedback.

Event-related Desynchronization of Mu Rhythms During Concentric and Eccentric Contractions

The purpose of this study was to compare the electroencephalographic (EEG) patterns and reaction times (RTs) of muscle activation between concentric and eccentric biceps brachii contractions under the RT paradigm and to evaluate how the EEG patterns and RTs changed with practice. Sixteen subjects performed 3 sets of 30 repetitions of submaximal voluntary concentric and eccentric biceps contractions. RT, event-related desynchronization (ERD) patterns of mu rhythm onset, and ERD amplitudes were selectively analyzed. Mental demand decreased as familiarity with the motor action increased due to practice regardless of contraction type. However, the 2 types of muscle contractions still have differences in brain activity regardless of decreased mental demand: eccentric contractions require earlier preparation than concentric contractions.

Load Accommodation Strategies and Movement Variability in Single-Leg Landing

Our purpose was to examine changes in participant-specific single-leg landing strategies and intra-individual movement variability following alterations in mechanical task demands via external load and landing height. Nineteen healthy volunteers (15M, 4 F, age: 24.3 ± 4.9 y, mass: 78.5 ± 14.7 kg, height: 1.73 ± 0.08 m) were analyzed among 9 single-leg drop landing trials in each of 6 experimental conditions (3 load and 2 landing height) computed as percentages of participant bodyweight (BW, BW + 12.5%, BW + 25%) and height (H12.5% & H25%). Lower-extremity sagittal joint angles and moments (hip, knee, and ankle), vertical ground reaction forces (GRFz), and electrical muscle activities (gluteus maximus, biceps femoris, vastus medialis, medial gastrocnemius, and tibialis anterior muscles) were analyzed. Individual single-leg drop landing strategies were identified using landing impulse predictions and the Load Accommodation Strategies Model (James et al., 2014). Intra-individual movement variability was assessed from neuromechanical synergies extracted using single-case principal component analyses (PCA). Fewer contrasting single-leg landing strategies were identified among participants under greater mechanical task demands (p < .001) alongside lesser intra-individual movement variability (p < .001). These results reveal changes in movement control under greater mechanical task demands, which may have implications for understanding overuse injury mechanisms in landing.

Cardiovascular and Muscular Consequences of Work-Matched Interval-Type of Concentric and Eccentric Pedaling Exercise on a Soft Robot

Eccentric types of endurance exercise are an acknowledged alternative to conventional concentric types of exercise rehabilitation for the cardiac patient, because they reduce cardiorespiratory strain due to a lower metabolic cost of producing an equivalent mechanical output. The former contention has not been tested in a power- and work-matched situation of interval-type exercise under identical conditions because concentric and eccentric types of exercise pose specific demands on the exercise machinery, which are not fulfilled in current practice. Here we tested cardiovascular and muscular consequences of work-matched interval-type of leg exercise (target workload of 15 sets of 1-min bipedal cycles of knee extension and flexion at 30 rpm with 17% of maximal concentric power) on a soft robotic device in healthy subjects by concomitantly monitoring respiration, blood glucose and lactate, and power during exercise and recovery. We hypothesized that interval-type of eccentric exercise lowers strain on glucose-related aerobic metabolism compared to work-matched concentric exercise, and reduces cardiorespiratory strain to levels being acceptable for the cardiac patient. Eight physically active male subjects (24.0 years, 74.7 kg, 3.4 L O2 min⁻¹), which power and endurance performance was extensively characterized, completed the study, finalizing 12 sets on average. Average performance was similar during concentric and eccentric exercise (p = 0.75) but lower than during constant load endurance exercise on a cycle ergometer at 75% of peak aerobic power output (126 vs. 188 Watt) that is recommended for improving endurance capacity. Peak oxygen uptake (−17%), peak ventilation (−23%), peak cardiac output (−16%), and blood lactate (−37%) during soft robotic exercise were lower during eccentric than concentric exercise. Glucose was 8% increased after eccentric exercise when peak RER was 12% lower than during concentric exercise. Muscle power and RFD were similarly reduced after eccentric and concentric exercise. The results highlight that the deployed interval-type of eccentric leg exercise reduces metabolic strain of the cardiovasculature and muscle compared to concentric exercise, to recommended levels for cardio-rehabilitation (i.e., 50–70% of peak heart rate). Increases in blood glucose concentration indicate that resistance to contraction-induced glucose uptake after the deployed eccentric protocol is unrelated to muscle fatigue.

Neuromuscular changes and the rapid adaptation following a bout of damaging eccentric exercise

INTRODUCTION

An initial bout of eccentric exercise is known to protect against muscle damage following a repeated bout of the same exercise; however, the neuromuscular adaptations owing to this phenomenon are unknown.

AIM

To determine whether neuromuscular disturbances are modulated following a repeated bout of eccentric exercise.

METHODS

Following eccentric exercise performed with the elbow flexors, we measured maximal voluntary force, resting twitch force, muscle soreness, creatine kinase (CK) and voluntary activation (VA) using motor point and motor cortex stimulation at baseline, immediately post-exercise and at 1, 2, 3, 4 and 7 days post-exercise on two occasions, separated by 3 weeks.

RESULTS

Significant muscle damage and fatigue were evident following the first exercise bout; maximal voluntary contraction (MVC) was reduced immediately by 35% and remained depressed at 7 days post-exercise. Soreness and CK release peaked at 3 and 4 days post-exercise respectively. Resting twitch force remained significantly reduced at 7 days (-48%), whilst VA measured with motor point and motor cortex stimulation was reduced until 2 and 3 days respectively. A repeated bout effect (RBE) was observed with attenuated soreness and CK release and a quicker recovery of MVC and resting twitch force. A similar decrement in VA was observed following both bouts; however, following the repeated bout there was a significantly smaller reduction in, and a faster recovery of, VA measured using motor cortical stimulation.

CONCLUSION

Our data suggest that the RBE may be explained, partly, by a modification in motor corticospinal drive.

Eccentric Exercise to Enhance Neuromuscular Control

Context:

Neuromuscular alterations are a major causal factor of primary and secondary injuries. Though injury prevention programs have experienced some success, rates of injuries have not declined, and after injury, individuals often return to activity with functionality below clinical recommendations. Considering alternative therapies to the conventional concentric exercise approach, such as one that can target neuromuscular injury risk and postinjury alterations, may provide for more effective injury prevention and rehabilitation protocols.

Evidence Acquisition:

Peer-reviewed sources available on the Web of Science and MEDLINE databases from 2000 through 2016 were gathered using searches associated with the keywords eccentric exercise, injury prevention, and neuromuscular control.

Hypothesis:

Eccentric exercise will reduce injury risk by targeting specific neural and morphologic alterations that precipitate neuromuscular dysfunction.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

Neuromuscular control is influenced by alterations in muscle morphology and neural activity. Eccentric exercise beneficially modifies several underlying factors of muscle morphology (fiber typing, cross-sectional area, working range, and pennation angle), and emerging evidence indicates that eccentric exercise is also beneficial to peripheral and central neural activity (alpha motorneuron recruitment/firing, sarcolemma activity, corticospinal excitability, and brain activation).

Conclusion:

There is mounting evidence that eccentric exercise is not only a therapeutic intervention influencing muscle morphology but also targets unique alterations in neuromuscular control, influencing injury risk.

Hemodynamic Response Alterations in Sensorimotor Areas as a Function of Barbell Load Levels during Squatting: An fNIRS Study

Functional near-infrared spectroscopy (fNIRS) serves as a promising tool to examine hemodynamic response alterations in a sports-scientific context. The present study aimed to investigate how brain activity within the human motor system changes its processing in dependency of different barbell load conditions while executing a barbell squat (BS). Additionally, we used different fNIRS probe configurations to identify and subsequently eliminate potential exercise induced systemic confounders such as increases in extracerebral blood flow. Ten healthy, male participants were enrolled in a crossover design. Participants performed a BS task with random barbell load levels (0% 1RM (1 repetition maximum), 20% 1RM and 40% 1RM for a BS) during fNIRS recordings. Initially, we observed global hemodynamic response alterations within and outside the human motor system. However, short distance channel regression of fNIRS data revealed a focalized hemodynamic response alteration within bilateral superior parietal lobe (SPL) for oxygenated hemoglobin (HbO₂) and not for deoxygenated hemoglobin (HHb) when comparing different load levels. These findings indicate that the previously observed load/force-brain relationship for simple and isolated movements is also present in complex multi-joint movements such as the BS. Altogether, our results show the feasibility of fNIRS to investigate brain processing in a sports-related context. We suggest for future studies to incorporate short distance channel regression of fNIRS data to reduce the likelihood of false-positive hemodynamic response alterations during complex whole movements.

Clinical Applications of Iso-Inertial, Eccentric-Overload (YoYo™) Resistance Exercise

In the quest for a viable non-gravity dependent method to "lift weights" in space, our laboratory introduced iso-inertial resistance (YoYo™) exercise using spinning flywheel(s), more than 25 years ago. After being thoroughly tested in individuals subjected to various established spaceflight analogs, a multi-mode YoYo™ exercise apparatus was eventually installed on the International Space Station in 2009. The method, applicable to any muscle group, provides accommodated resistance and optimal muscle loading through the full range of motion of concentric actions, and brief episodes of eccentric overload. This exercise intervention has found terrestrial applications and shown success in enhancing sports performance and preventing injury and aiding neurological or orthopedic rehabilitation. Research has proven that this technique offers unique physiological responses not possible with other exercise hardware solutions. This paper provides a brief overview of research that has made use, and explored the efficacy, of this method in healthy sedentary or physically active individuals and populations suffering from muscle wasting, disease or injury. While the collective evidence to date suggests YoYo™ offers a potent stimulus to optimize the benefits of resistance exercise, systematic research to support clinical use of this method has only begun to emerge. Thus, we also offer perspectives on unresolved issues, unexplored applications for clinical conditions, and how this particular exercise paradigm could be implemented in future clinical research and eventually being prescribed. Fields of particular interest are those aimed at promoting muscle health by preventing injury or combating muscle wasting and neurological or metabolic dysfunction due to aging or illness, or those serving in rehabilitation following trauma and/or surgery.

Enhanced Corticospinal Excitability and Volitional Drive in Response to Shortening and Lengthening Strength Training and Changes Following Detraining

There is a limited understanding of the neurological adaptations responsible for changes in strength following shortening and lengthening resistance training and subsequent detraining. The aim of the study was to investigate differences in corticospinal and spinal responses to resistance training of the tibialis anterior muscle between shortening or lengthening muscle contractions for 4 weeks and after 2 weeks of detraining. Thirty-one untrained individuals were assigned to either shortening or lengthening isokinetic resistance training (4 weeks, 3 days/weeks) or a non-training control group. Transcranial magnetic stimulation and peripheral nerve stimulation (PNS) were used to assess corticospinal and spinal changes, respectively, at pre-, mid-, post-resistance training and post detraining. Greater increases changes (P < 0.01) in MVC were found from the respective muscle contraction training. Motor evoked potentials (expressed relative to background EMG) significantly increased in lengthening resistance training group under contraction intensities ranging from 25 to 80% of the shortening and lengthening contraction intensity (P < 0.01). In the shortening resistance training group increases were only seen at 50 and 80% of both contraction type. Volitional drive (V-wave) showed a greater increase following lengthening resistance training (57%) during maximal lengthening contractions compared to maximal shortening contractions following shortening resistance training (23%; P < 0.001). During the detraining period MVC and V-wave did not change (P > 0.05), although MEP amplitude decreased during the detraining period (P < 0.01). No changes in H-reflex were found pre to post resistance training or post detraining. Modulation in V-wave appeared to be contraction specific, whereby greatest increases occurred following lengthening resistance training. Strength and volitional drive is maintained following 2 weeks detraining, however corticospinal excitability appears to decrease when the training stimulus is withdrawn.

Standard and Short RoM Isokinetic Testing: Comparative Analysis in Identifying Submaximal Shoulder External Rotator Effort

An isokinetic-related parameter termed the difference between eccentric-concentric strength ratios at two distinct test velocities (DEC) based on 60° (standard) range of motion (RoM) has been proven to be highly efficient detecting feigned muscular efforts. This study aimed to verify whether a DEC derived from a much shorter test RoM (20°) was equally useful than a long RoM-derived one. Eighteen healthy men (32.4 ± 6.4 years old) took part in a study focusing on shoulder external rotation isokinetic strength. Participants performed a genuine shoulder external rotator maximal effort (eight pairs of concentric and eccentric contractions at high and low velocities at short and long RoM) and then instructed to feign maximal effort. Contraction velocities were adjusted accordingly by applying a 1:4 gradient and peak moments registered. Both condition DEC was then calculated by subtracting the eccentric and concentric strength ratios at low velocities from those at high velocities. DEC scores in the feigned effort were significantly higher than maximal effort ones in both conditions in men. It enabled the setting of specific cutoff levels for separating the efforts. Both approaches revealed a coincident sensitivity (78%) whereas short RoM showed an even higher specificity: 88% versus 78%. Thus, the short RoM protocol provides clinically acceptable detection power.

Moderate Load Eccentric Exercise; A Distinct Novel Training Modality

Over the last 20 years a number of studies have been published using progressive eccentric exercise protocols on motorized ergometers or similar devices that allow for controlled application of eccentric loads. Exercise protocols ramp eccentric loads over an initial 3 weeks period in order to prevent muscle damage and delayed onset muscle soreness. Final training loads reach 400-500 W in rehabilitative settings and over 1200 W in elite athletes. Training is typically carried out three times per week for durations of 20-30 min. This type of training has been characterizes as moderate load eccentric exercise. It has also been denoted RENEW (Resistance Exercise via Negative Eccentric Work by LaStayo et al., 2014). It is distinct from plyometric exercises (i.e., drop jumps) that impose muscle loads of several thousand Watts on muscles and tendons. It is also distinct from eccentric overload training whereby loads in a conventional strength training setting are increased in the eccentric phase of the movement to match concentric loads. Moderate load eccentric exercise (or RENEW) has been shown to be similarly effective as conventional strength training in increasing muscle strength and muscle volume. However, as carried out at higher angular velocities of joint movement, it reduces joint loads. A hallmark of moderate load eccentric exercise is the fact that the energy requirements are typically 4-fold smaller than in concentric exercise of the same load. This makes moderate load eccentric exercise training the tool of choice in medical conditions with limitations in muscle energy supply. The use and effectiveness of moderate load eccentric exercise has been demonstrated mostly in small scale studies for cardiorespiratory conditions, sarcopenia of old age, cancer, diabetes type 2, and neurological conditions. It has also been used effectively in the prevention and rehabilitation of injuries of the locomotor system in particular the rehabilitation after anterior cruciate ligament surgery.

Brain Functional Connectivity Is Different during Voluntary Concentric and Eccentric Muscle Contraction

Previous studies report greater activation in the cortical motor network in controlling eccentric contraction (EC) than concentric contraction (CC) of human skeletal muscles despite lower activation level of the muscle associated with EC. It is unknown, however, whether the strength of functional coupling between the primary motor cortex (M1) and other involved areas in the brain differs as voluntary movements are controlled by a network of regions in the primary, secondary and association cortices. Examining fMRI-based functional connectivity (FC) offers an opportunity to measure strength of such coupling. To address the question, we examined functional MRI (fMRI) data acquired during EC and CC (20 contractions each with similar movement distance and speed) of the right first dorsal interosseous (FDI) muscle in 11 young (20-32 years) and healthy individuals and estimated FC between the M1 and a number of cortical regions in the motor control network. The major findings from the mechanical and fMRI-based FC analysis were that (1) no significant differences were seen in movement distance, speed and stability between the EC and CC; (2) significantly stronger mean FC was found for CC than EC. Our finding provides novel insights for a better understanding of the control mechanisms underlying voluntary movements produced by EC and CC. The finding is potentially helpful for guiding the development of targeted sport training and/or therapeutic programs for performance enhancement and injury prevention.

The effect of intervention according to muscle contraction type on the cerebral cortex of the elderly

[Purpose] Here we investigated the activity of the cerebral cortex after resistance training in the elderly. We evaluated the clinical neuropsychological basis of 2 contractile types, and determined the usefulness of a movement-related cortical potential (MRCP) from an electroencephalography (EEG). [Subjects and Methods] The subjects were 11 females and 11 males aged between 65 and 70 years. The subjects were randomly assigned into a group that performed an eccentric contraction exercise (experimental group I, n=11) and a group that performed a concentric contraction exercise (experimental group II, n=11). We measured activities of the rectus femoris, vastus medialis, and vastus lateralis in the non-dominant lower extremity by using surface electromyography (EMG), and measured brain activity using EEG before conducting an intervention. An intervention was conducted 40 minutes per session, once a day, 3 times a week for 4 weeks. [Results] After the intervention, activity in C4, the Cz area and rectus femoris were significantly different. [Conclusion] Our results demonstrate that MRCP from an EEG has the advantage of being non-invasive and cost-effective. Nonetheless, prospective studies are needed to reveal the specific mechanism underlying eccentric contraction exercise, which can provide baseline data for research related to aging and neural plasticity.

Changes in cortico-spinal excitability following uphill versus downhill treadmill exercise

An acute bout of aerobic exercise induces neuroplasticity in the motor cortex. Moreover, paired associative stimulation (PAS) is known to induce neuroplasticity in M1. However, the possible influence of the type of exercise on the neuroplastic changes remains unknown. The present study investigated the effects of two different modes of muscle contraction produced during locomotor exercise on changes in corticospinal (CS) excitability. Subjects performed two 30-min treadmill exercises at an intensity corresponding to 60% of their maximal heart rate with either a +10% (uphill) or -10% (downhill) slope. These exercises were followed or not by paired associative stimulation method (PAS₂₅) which consisted of 200 paired stimuli (0.25Hz, 15min) of median nerve electrical stimulation followed by transcranial magnetic stimulation of the hand M1 area (ISI 25ms). Motor evoked potentials (MEP), assessed through abductor pollicis brevis (APB) activity were obtained before exercise, at 5min, 15min and 30min after exercise. A significant (P<0.05) increase of the MEP amplitude was observed 30min after both exercises but was not different between the two modes of locomotion. On the contrary, MEP amplitude with PAS₂₅ increased only 30min after downhill exercise. We conclude that sub-maximal treadmill exercise increases CS excitability within a period of 30min. However, the predominant mode of muscle contraction during uphill versus downhill locomotion does not influence CS excitability when assessed using a non-exercised muscle. However, results from PAS₂₅ suggest that specific neuroplastic changes occur likely due to homeostatic mechanisms induced by exercise plus a PAS protocol.

Eccentric resistance training increases and retains maximal strength, muscle endurance, and hypertrophy in trained men

The aim of the present study was to evaluate the effects of different resistance training protocols on muscle strength, endurance, and hypertrophy after training and detraining. Thirty-four resistance-trained males were randomized in concentric-only (CONC), eccentric-only (ECC), traditional concentric-eccentric (TRAD) bench press resistance training or control group. The training volume was equalized among the intervention groups. Bench press of 1-repetition maximum (1RM)/body mass, maximum number of repetitions (MNR), and chest circumference were evaluated at the baseline, after 6 weeks of training, and after 6 weeks of detraining. All intervention groups reported significant 1RM/body mass increases after training (CONC baseline: 1.04 ± 0.06, post-training: 1.12 ± 0.08, p < 0.05; ECC baseline: 1.08 ± 0.04, post-training: 1.15 ± 0.05, p < 0.05; TRAD baseline: 1.06 ± 0.08, post-training: 1.11 ± 0.10, p < 0.05). After detraining, only ECC retained 1RM/body mass above the baseline (1.17 ± 0.07, p < 0.05), while CONC and TRAD returned to baseline values. Only ECC improved and retained MNR (baseline: 22 ± 3; post-training: 25 ± 3, and post-detraining: 25 ± 4, p < 0.05 compared with baseline) and chest circumference (baseline: 98.3 ± 2.4 cm, post-training: 101.7 ± 2.2 cm and post-detraining: 100.7 ± 2.3 cm. p < 0.05 compared with baseline), while no significant changes occurred in both CONC and TRAD. The incorporation of eccentric training can be recommended for counteracting the negative effects of detraining or forced physical inactivity.

Muscle, functional and cognitive adaptations after flywheel resistance training in stroke patients: a pilot randomized controlled trial

BACKGROUND

Resistance exercise (RE) improves neuromuscular function and physical performance after stroke. Yet, the effects of RE emphasizing eccentric (ECC; lengthening) actions on muscle hypertrophy and cognitive function in stroke patients are currently unknown. Thus, this study explored the effects of ECC-overload RE training on skeletal muscle size and function, and cognitive performance in individuals with stroke.

METHODS

Thirty-two individuals with chronic stroke (≥6 months post-stroke) were randomly assigned into a training group (TG; n = 16) performing ECC-overload flywheel RE of the more-affected lower limb (12 weeks, 2 times/week; 4 sets of 7 maximal closed-chain knee extensions; <2 min of contractile activity per session) or a control group (CG; n = 16), maintaining daily routines. Before and after the intervention, quadriceps femoris volume, maximal force and power for each leg were assessed, and functional and dual task performance, and cognitive functions were measured.

RESULTS

Quadriceps femoris volume of the more-affected leg increased by 9.4 % in TG. Muscle power of the more-affected, trained (48.2 %), and the less-affected, untrained limb (28.1 %) increased after training. TG showed enhanced balance (8.9 %), gait performance (10.6 %), dual-task performance, executive functions (working memory, verbal fluency tasks), attention, and speed of information processing. CG showed no changes.

CONCLUSION

ECC-overload flywheel resistance exercise comprising 4 min of contractile activity per week offers a powerful aid to regain muscle mass and function, and functional performance in individuals with stroke. While the current intervention improved cognitive functions, the cause-effect relationship, if any, with the concomitant neuromuscular adaptations remains to be explored.

TRIAL REGISTRATION

Clinical Trials NCT02120846.